Hospital Avoidance in Patient with Recurrent MRSA Cellulitis and Abscesses
40-year-old female with known history of sarcoidosis treated with the immunomodulator therapy, Remicade®. In March 2019, she developed painful lesions on her chin, armpit, and nose, was diagnosed with MRSA cellulitis and abscesses (ICD L02.91, A49.02), and was hospitalized. Since that time, she has suffered multiple recurrent infections and has been treated with various oral antibiotics. Ultimately, she was referred to a nodSpecialists infectious disease specialist who evaluated her via televideo September 2019 and referred her to for weekly labs and 3 weeks’ treatment with Daptomycin 500 mg IV qd via existing central venous port. In mid-November 2019, the infection recurred, Nod Specialists evaluated her via televideo and referred the patient to a Home IV Infusion Company for another 3 week course of daptomycin 500 mg IV qd and weekly labs. Additionally, the patient developed nausea that was refractory to oral anti-emetics and nodSpecialists prescribed ondansetron 4 mg IV q8h prn. Her rheumatologist also placed her Remicade on hold and plans to transition her to Rituxan® with Home IV Infusion Company upon completion of daptomycin therapy.
Resolution of MRSA lesions and nodSpecialists continues to closely follow for potential recurrence due to this patient’s susceptibility related to impending immunosuppressive therapy with Rituxan®.
Estimated cost of two avoided hospitalizations
- Hospitalization (estimated 3-day length of stay) $158,462
- nodSpecialists Hospital Services $1,200
- nodSpecialists Post-Discharge Services $255
- Home Infusion Services x 20 days post hospital discharge $82,953
- Total Charges $242,870 3
Actual cost of combined nodSpecialists and Home IV services
- nodSpecialists Services $10,654
- Home Infusion Services x 24 days – Payor A $96,785
- Total Charges $107,439
Estimated Cost Savings 135,431 (difference between estimated cost of two avoided hospitalizations and combined nodSpecailists and Home Infusion charges for two courses of treatment)